Inna serves the hidden population of Indonesian women who are pregnant but can not easily obtain information or see a doctor because of social and legal barriers.
The New Idea
Inna’s organization, Samsara, is the first in Indonesia to provide direct, unbiased, and complete information to women with unplanned pregnancies. Samsara’s information and counseling services create structure in an invisible, unorganized-- though consistently large and urgent-- area of need. With a hotline, popular web presence, and interactive chat platform, Samsara connects with women throughout the country who may have no other source of knowledge and support.
In dealing with this uncomfortable reality, she prioritizes the health, safety, and privacy of women. Her first goal is to avert the dangerous situation of women seeking illicit, unsafe abortions from unlicensed facilities or traditional folk practices. Complications from such underground procedures injure and even kill and unknown number of women each year. Another goal is to help women avoid counterfeit drugs sold for the purpose of self-induced termination. Instead, she offers anonymous counseling on all aspects of pregnancy, as well as counseling women though their options for dealing with unplanned pregnancy.
Inna is also active in reproductive health education for teenagers. Samsara’s unique experience provides ample real-world examples from which to draw messages, and the organization’s expertise in communication allows it to speak on terms familiar with young people. She developed a method she calls the Sexuality and Reproductive Health School, where participants learn about their bodies and openly talk about the considerably taboo subjects of sex and sexuality. By now almost eight thousand young people from all over Indonesia have taken part and are now virtually connected.
Inna has also teamed up with regional and international networks in reproductive health, including the Women on Waves, Asia Safe Abortion Partnership, Women's Global Network for Reproductive Rights, and the International Consortium for Medical Abortion. Within this coalition, she leads an international task force to help organizations in other countries to improve their hotline and outreach services, drawing on Samsara’s success in Indonesia.
Despite the prevalence of unplanned pregnancy, the law greatly restricts women’s access to medical information and services. Abortion is illegal, except in cases of married women who obtain the consent of their husbands and approval of a doctor. Single women, teenagers, and married women who do not wish to seek their husband’s permission are all prevented by law from accessing abortion or anonymous reproductive health services.
Without access to doctors, women seek illicit and dangerous abortions that threaten their health and well being. In addition to physical dangers such as infection or post-partum bleeding, women may also suffer depression, anxiety and post-traumatic stress.
The cultural consequences of pregnancy out of wedlock are also severe. Banishment from home, social isolation, and even violence may occur.
The result is a public health crisis and an absence of useful services to women whose health, safety, families, and futures are at stake. And the crisis goes beyond pregnancy to host of issues related to sexual behavior, including disease transmission, decisionmaking, and communication.
Multiple surveys have revealed facets of the overall problem, public policy has not kept with reality. A third of all illegal abortions are performed on teenagers, and the rate of teenage pregnancy is growing at 15% per year. An estimated 22% of single women in the greater Jakarta area report experience with unplanned pregnancy.
In response to these realities, a large underground sector has emerged, consisting of unlicensed clinics and grey-market drug dealers. Meanwhile, the internet is rife with false, contradictory, or misleading information. Unless Indonesia finds a new approach to this difficult and sensitive issue, women will continue to suffer fear and uncertainty.
Samsara first started as a hotline counselling service for post abortion syndrome, which later transformed into comprehensive counselling on unplanned pregnancy due to popular demand. The aim is to give women the most accurate information possible to keep them safe. This approach is aligned with latest recommendation of the World Health Organization, and it constitutes a harm reduction model from public health perspective. In a setting where abortion is restricted, Samsara safe abortion hotline has saved lives of thousands of women who would otherwise have fallen victim to unsafe methods.
What started as a hotline has grown to a multi-pronged information service. To the telephone hotline Samsara has added websites and mobile apps that allow an even greater degree of anonymity. They answer questions and provide information through chat. While the hotline fields about six hundred calls per month, the website sees over ten thousand hits.
Samsara staff-- who themselves have diverse cultural and religious backgrounds and beliefs-- gather basic information, help determine the gestational age of the pregnancy, and talk to callers about their options: parenting, adoption, or safe abortion. They provide callers with information on reliable sources of misoprostol (a pill that induces miscarriage), or doctors who are willing to perform surgical abortions. They are also well-versed in World Health Organization (WHO) protocols on how to use misoprostol, and they explain to women what to watch out for, how to deal with complications, what to tell a doctor if they must go to the hospital, and how to make sure the abortion succeeded. They are also supervised by doctors as consultants.
On the preventive side, Inna first developed Sexuality and Reproductive Health School (SRHS) – weekend sessions to provide knowledge and skills so that everyone should have controls over their body and basic skills to do self-treatment. With funding support from HIVOS-Netherland Fund, Inna piloted in Yogyakarta a small group of 15 boys and girls from various backgrounds. Sessions are conducted twice a week (every Saturday and Sunday) for intensive two months Attendance is free of charge but those who skip more than 3 sessions are considered quit and must pay fine.
Inna and her team at Samsara created the curriculum covering eight topics: (1) Basic concept of Sexuality and Reproductive Health, includes gender identities, sexual diversity, sexual and reproductive rights; (2) Anatomy and physiology of reproductive organs includes menstruation, breast health, contraception, pregnancy, birth, and breastfeeding; (3) Abortion, includes women and abortion, abortion in Indonesia and abortion counseling; (4) Sexually Transmitted Infections; (5) Safe sex & Sexual pleasure, includes taboo and myths; (6) Emotions & Relationships includes stress management, healthy relationship and violence; (7) Body Autonomy, includes the body image, myth of beauty, media, religion and culture; and (8) Physical includes Bi-manual exams, breast self-exam, vaginal and cervical exams.
Finding difficulties to explain concepts, and knowing that the best way to learn is using the five senses, Inna came out with the idea of Body Model module; with other 4 volunteers, they got to physically show that every human body is different. Most of young people live in their own fantasy and are often driven by false myths around their body image. By seeing the models, who have different types of body, the participants learn to accept their body’s uniqueness. Inna also developed.
Inna took this curriculum to wider audience in rural areas through monthly workshops in Yogyakarta and surrounding 4 districts. Satellite workshops, an integrated education and advocacy program, are conducted outside Java, among which in Bali, Lombok, Flores, and Sulawesi. All information about the sex and reproduction health and right education, safe abortion, and sexual transmitted diseases are accessible through the website and cloud system, and soon a mobile app. 2011 Samsara’s database noted that more than 70% workshop alumni (age 18-24 years) are still active in the hotline and engage with Samsara’s social media. To serve the full spectrum of care, Inna is currently planning a shelter as a safe space for pregnant girls who choose delivery instead of abortion.
Inna is coordinating an international program to build this hot-line for women facing un-wanted pregnancies. She sees her role outside Indonesia as much as she is committed to creating a diverse group of leaders in Indonesia to continue Samsara’s work. Samsara is among the few that can provide hands on data on safe abortion to support evidence-based advocacy.
Beyond urban setting, Inna tested her idea in rural Eastern Indonesia, where access to information and service is dire. Through Satellite Workshop, a six-week educational and advocacy program, Inna engages village communities, local civil society organizations, high schools, Islamic Boarding schools, Church communities and universities to conduct workshop on sexual and reproductive health for youth. Post the workshop, youth participants continue to engage with Samsara as peer educators. In addition to education, the program also mapped out abortion issue and access to reproductive health services (including availability of Misoprostol as part of safe abortion).
Inna Hudaya was born in a very religious family in Tasikmalaya, West Java. Her parents enrolled her in junior high school at an Islamic boarding school in Garut. She found that the intense focus on prayer and strict religious observation did not bring her peace, but discomfort.
She bridled at instructions not to make friends with people of different religions or with girls not wearing the hijab. She felt her individual rights being ignored, as she had no say in family decisions about her education. She often debated and sometimes got her way, coming to be seen as disobedient at home.
In high school, Inna decided to leave her family and Tasikmalaya city, believing that many good things awaited outside of her home town. She wanted to learn more about the world; otherwise, she would have to accept things that are against her will. In 2000, after graduating from high school, she was finally able to go to Yogyakarta. The decision was made after a long and hard negotiation with her parents, who finally agreed, provided Inna study medicine-- rebellious and outspoken, Inna was also an excellent student. She opted for law instead, at the Indonesia Islamic University. She discovered more open and moderate views of Islam and fell in love with her studies. Found out by her parents, in 2001, she was forced again to study medicine.
In 2002, her father passed away and Inna got a head trauma from a motorcycle accident. In the same year she also had TORCH-CMV (common infections associated with congenital anomalies), which made her weak and disoriented and could not focus on her study for months. In 2003, Inna experienced an unplanned pregnancy. She could not tell her family as they are very religious. Getting pregnant while studying is also against the campus policy. So, Inna decided to have an abortion. She underwent an unsafe abortion. It was so painful that made her feel like she wanted to die. She felt lonely as she faced everything by herself. Her boyfriend deserted her when he knew she was pregnant. Inna had post abortion psychosomatic trauma that forced her to give up her study and focused on her recovery. The psychiatry consultations and her medical treatment have made her broke and in debt. She could not find a way out but to finally talk to her family in 2007. Beyond her expectation, her mother accepted her condition but not her brother, who said that her blood was halal (permissible under the Islamic Syariah) to be killed. She never had any communication ever since with her brother.
At the same time, she read an article stating that there are 2 million abortions a year in Indonesia. She was wondering what if 50% of them had a trauma just like her, having the feeling to give up and die. Those women did not have a place to share the feelings. She started to write her story on her blog. She talked about her recovery process from being guilty and feeling worthless. She got lots of responses from women who went through the same path as hers. In the meantime, Inna read a lot of scientific medical and psychological journals, through which she learned that stress due to post abortion trauma is normal and can be felt by all women, but can be managed.
In 2007, she briefly came to Jakarta to find some work. She got a job on a television program as a comedian then internship as a journalist on a television station. She also met with her respondent of her blog, Grace. But she felt Jakarta was not her home, so she moved back to Yogyakarta in 2008 and kept the correspondence with Grace and another girl friend name Kiky. Together they then agreed to establish Samsara that means Reborn as a supporting group for women who had unplanned pregnancy and undergone abortion.